xt79gh9b6s69 https://exploreuk.uky.edu/dips/xt79gh9b6s69/data/mets.xml The Frontier Nursing Service, Inc. 1973 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 48, No. 3, Winter 1973 text Frontier Nursing Service Quarterly Bulletin, Vol. 48, No. 3, Winter 1973 1973 2014 true xt79gh9b6s69 section xt79gh9b6s69 Jfrnntier jiursing éerhiee
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The cover picture was iirst l
used on the Spring, 1960
issue of Frontier Nursing _
Service Quarterly Bulletin ·
and was printed by pem1is—
sion of The Medici Society, ·
Ltd., 34-44 Pentonville Road, _
London, N.1, England. ` `
Published at the end of each Quarter by the Frontier Nursing Service, Inc.
Lexington, Ky.  j
Subscription Price $1.00 a Year  Q
Edit0r’s Office: ‘v€I1d0V€l‘, Kentucky 41775  ‘
Second class postage paid at Lexington, Ky. 40507  -
Send Form 3579 to Frontier Nursing Service, Weudover, Ky. 41775 ?
Copyright, 1973, Frontier Nursing Service, Inc.  {

 é f
4 Beyond the Mountains 46
Coping With Faniily Planning
In A Rural Area VV. B. R. Beasley, M.D. 3
i Curing and Caring 11
  Deep Peace . . . Fiona MacLeod 2
~   Field Notes ‘ 41
} In Memoriam 29
Q Old Courier News 27
    Old Staff News 31
A Sanitation: Principles of
V — Promotion and Maintenance
of Health Lucille Lebeail 13
j The Big House in the Snow A Plzyotogiviplr, Inside
. g Back Cover
{ I A Grandfather Presented . . . Modern Maturity 26
,, Cavy The Couiitrymaii 40
Franklin’s Friend The Colonial Crier 10
A On the Way . . . Modern Maturity 44
 C Q Overheard Contributed 12
That Language Barrier The Colonial Crier 47
g.  This Time, IT‘S A GIRL! 30
 ‘ White Elephant 45
I 1

2 1¤·RoN·rn2R NURSING snnvron _  
E 1
l 1
The following verse was sent to us by Dr. Berta
Hamilton of Brattleboro, Vermont. We Wish to share it
with our friends, and especially with those families _
whose men served their country in southeast Asia.
Deep peace of the morning wave to you, 7
Deep peace of the flowing air to you,
Deep peace of the quiet earth to you,  
Deep peace of the sleeping stones to you,
Deep peace from the Son of Peace to you. f
—Fi0na M acLe0d
1855-1905 y
N 1

a 1 by
! yl Reprinted, with permission, from
o Vol. 41, No. 1, January 1973
Published by the Medical Department
· Harper and Row Publishers, Inc.
Copyright © 1973 by
American College of Obstetricians and Gynecologists
In a 750-square mile mountain area of East Keninicky, the Fron-
» tier Nursing Service includes family planning as part of the total
health care provided through an extensive network of nurse-
p midwives and family 11urses decentralized into six nursing out-
posts supported by a physician and nurse-midwifery team located
; at the central hospital. During a 10-year period, the bi1·th rate
’ was reduced from 41 to 15; midwives inserted intrauterine contra-
ceptive devices, achieving a continuation rate of 59 at 4 years.
The continuation rate for pill users was 42 at 4 years. In the
past 2 years, '70% of the women delivered accepted family plan-
’ ning. Sterilizations, 38% of which were vas ligations, were equal
to 20% of the deliveries. Except for sterilizations, nurse-
· midwives provide all family plaiming services.
As a basis for observations on "coping with family planning
» in rural areas," the Frontier Nursing Service will be described
as a rural model of health care which has dealt with the classic
K I problems of all health programs—manpower, facilities, trans-
‘ 1 portation and money} The principles which the Frontier Nursing
'   Service has used to solve these problems are not new,2 but in this
' Family Planning Program they have been successfully applied
as follows:
  1. Professional manpower for family planning can be
 I available through the use of nurse-rnidwives as effec-
 ‘ tively, and less expensively, than that provided by
 ’ · physicians?
J, 2. Facilities used can be those existing for other aspects
a of health care.

4 r·RoN·1·1En NURSING snavxcm    
3. Transportation is best solved by decentralizing serv-  
4. And money is better spent and perhaps more avail-  I,
able when family planning is incorporated into exist-
ing maternal and child care and general health pro-  
grams. E
The rural area for these observations is Eastern Kentucky;  I
the mountains—Appalachia—where the number of physicians  I
has decreased by 20% in the past 10 years; where the physician __
population ratio is 60 per 100,000 compared with 150 per 100,000  —
for the nation. Ir1 the particular area in which this rural health gl
care model will be described, the physician population ratio is  I
even less—approximately 20 per 100,000 or 1 doctor for 5000  I
In Eastern Kentucky, hospital beds are few and are princi- ;,
pally those of the Appalachian Regional Hospital System, a ,
non-profit corporation which now owns and manages the chain  
of nine modern hospitals which were built by the United Mine  I
Workers Union a decade ago. Coal is still the principal industry,  I
and as strip mining increases, employment decreases. Timber and  e
manpower are the other signiiicant exports from the region.  I
In such a multicounty area, covering 750 square miles and  ,
a population of 18,000, the Frontier Nursing Service is a model  "
for rural health care. The Frontier Nursing Service is a 45-year-  I
old voluntary organization whose staff of Nurse-Midwives and  
Family Nurses provide comprehensive, family centered, maternal  ,
and child care. It owns and operates a centrally located 26-bed  I
hospital, where physicians are based and where there is an out- ,
patient clinic servicing approximately 100 patients a day. But I I
the chief facilities for health care are 6 nursing outposts, each I ;
of which acts both as a residence and as a clinic for District ,
Nurses and Nurse-Midwives. Each nursing outpost (or neighbor- ,
hood clinic) is staffed by 2 or 3 nurses who provide comprehensive
health care to the 400 families of their district by means of their  I
specialty skills, written medical directives, telephone or radio  I
communication with the hospital-based physicians and specialty  
The original nurse-midwives were British trained, but in  ,
1939 the Frontier Nursing Service established its own Graduate  

 i School of Nurse-Midwifery, at which approximately one-third of
E? all American trained nurse-midwives have been trained. In 1970,
 ;_ this training was broadened to include Family Nursing, which
l provides special skills enabling the nurse-midwife to diagnose and
‘ manage health care problems common to the area.5·°
4 The principal health manpower at the Frontier Nursing
 ‘ Service is the Nurse-Midwife. She obviously must focus on
 Q mother and baby, but, in doing so, she will offer care to the entire
‘ family. The broader Family Nurse training is to assure neces-
 ; sary clinical skills.
, In their first 10,000 deliveries, most of which were in the
 , home, these rural nurse—midwives achieved a maternal mortality
 i rate of 11 per 10,000 live births, at a time when that of the
 Q nation was 34 per 10,000 live births and that of Kentucky was
I essentially the same. In the past 20 years there has been no
i' maternal death in the Frontier Nursing Service? A great dif-
4  ference between the Nurse-Midwife and the Obstetrician is the
 ‘ Nurse-Midwife’s ability—indeed her duty—to make a home visit
 . when the patient fails to keep a clinic appointment, thus prevent-
Ai  ing many problems in pregnancy. In contrast, the Obstetrician
 · is at the mercy of the patient who fails to come to clinic. This
 Y distinction may partially account for the decrease in maternal
 i deaths in an area where Nurse-Midwives provide the maternal
- care.
‘ In the middle of the 1950’s the delivery load at the Frontier
‘ Nursing Service was over 500 babies a year; this area had the
 A highest reported birth rate in the nation? The only family plan-
 1 ning was the traditional diaphragm and jelly; although tubal liga-
, tions were available for grand multipara with eight live born
 _ children, few sterilizations were requested.
4 Dr. John Rock, a longstanding friend of the Frontier Nursing
. Service, visited in 1957 and offered to include the Nurse-Midwifery
; Service as part of the research program in oral contraception. A
, limited ntunber of cycles were provided for a 3-year period, and
} through this program the Frontier Nursing Service learned: a)
 A that pills will prevent pregnancy; b) that the woman’s motivation
  was the chief limiting factor for continuing the technic; and c)
  that nurse—midwives could maintain that motivation and also
. could select appropriate women for oral contraceptive use. When
Y the FDA approved oral contraceptives in 1961, the numbers of

. . . . 1
women who were given these increased significantly, and a formal l
postpartum family planning program began. _1
Then in 1964 the intrauterine contraceptive devices——coils,  1;
bows, 1oops—found their way into the mountains as an inexpen- ,
sive alternative to pills, no longer supplied free for research. "
These were introduced by the physician at the time of the 6-week V"
postpartum or postabortal check. They had great appeal to those {
student nurse-midwives who were returning to overseas mission l
hospitals.; and soon the entire nurse-midwifery faculty and staff Q
accepted intrauterine contraceptive devices as part of midwifery j
and of maternal and child health care. Including family planning  Q
in midwifery means that nurse-midwives must be trained in the  5
use and limitations of contraceptive technics so that they are able 1
to motivate, teach and counsel patients in family planning, as  i
well as provide technical services, including a speculum and bi-  V
460  ·
. ¤°°  n
40 ¤:..°'·•,_. °° :-5-:%.-.  Q;
° ° ¤ 0.;,4.....*. ¤° '·._·  
Oo ',· F
350 °°’·._ I
°°'··. ..... E é
° 2
300 ° ° ¤ MQ., 6 ° 1
Q ¤ ¤ ° O ° ¤ ¤  I
250 1 ·__,••·.,_·  I
200  ·
. 1
IOO ___ ,`_ x
"` ,’r"'-`~ `vl/’ "-'°"`_""'T ))
1960 1962 1964 1966 1966 1970  Qi
Birth r¤te/ l0,000 ••··••··••· Primlpdrus ------ ~
Total blrths ¤ ¤ ¤ ¤ ¤ New fumily planners -—- _
Fig I. Analysis of 10-years of family planning by nurse- 4
midwives—l960 to l970. 1

  manual pelvic examination, cytologic smear, insertion or removal
4. of intrauterine contraceptive devices and the introduction of oral
 ~, contraceptives. The readiness with which patients accepted the
intrauterine device was doubtless influenced by the attitudes of
 *` the nurse-midwives.
;£ The Nurse-Midwives’ postpartum clinic then initiated contra-
`. ception for the mother and immunization for the infant. And
Q these important preventive services were continued at a combined
. Family Planning and Baby Clinic. These clinics, at the centrally
. located hospital and at the 6 nursing outposts, are managed by
{ nurse-midwives under medical supervision—which means the
if  physician is available on the premises or by telephone if needed.
 ` These clinics are extremely useful settings for teaching student
 = nurse-midwives and family nurses how to examine the non-
2 pregnant pelvis. Although family planning has been incorporated
A  into the practice of midwifery, it is sufficiently distinct from it
.;  to receive referrals from general patient clinics, to provide pre-
  marital counseling and to undertake subfertility studies.
 ;, In the summer of 1970, the Student American Medical Asso-
A  ciation placed a medical student at the Frontier Nursing Service
 A to study this system of health care with its nursing specialties
g and skills. This student analyzed the 10 years of family planning
  by nurse-midwives from 1960 to 1970 and discovered the very
 A. interesting data presented in Figure 1. During the 10-year period,
 ` the annual number of births decreased by 30% while the birth
1 rate decreased by 60%. The population showed a very slight
  increase of 7%, and the proportion of childbearing women in-
creased by 2%." The actual number of primiparas remained
, stable during this time and the annual number of women begin-
p Aggregate
 ', ’I.00'h'L(1·'l'L ’m,0’l'Lth8
 ; Months Method Rate of use
i 36 Oral 58.1 6,213
 r IUCD 65.7 9,183
.. 48 Oral 42.0 6,705
` 1"UCD 59.1 10,357
. 60 Oral 58.2 11,034
 . IUCD-—i.ntrauteri.ne contraceptive device

ning family planning climbed steadily, almost reaching the num-  
ber of annual deliveries.  I
Table 1 shows that the continuation rate for pill users was V,
42.0 at 4 years; for intrauterine devices at 4 years the rate was
59.1. Twelve months later, at the end of the iifth year, the con-
tinuation rate of intrauterine devices is essentially unchanged. i
These rates can be interpreted as great patient demand as well il
as adequate skills in family planning by nurse-midwives.  I
To confirm this encouraging 10-year scan, during which pr 
period family planning became as much a part of midwifery as  l
are the effo-rts to prevent and control preeclampsia, a study was  lz
made of the deliveries by the Frontier Nursing Service in the  
next 2 years 1970 and 1971; of the 570 women delivered, 82%  T
completed their 6-week check up.  T
Figure 2 shows that only 40% of these deliveries had used  :
family planning before this delivery; the 703% that accepted  
family planning after delivery have a breakdown of: 30% took  Q
pills, 28% used intrauterine contraceptive devices and 12% had  
sterilizations.  3
Before delivery  
After delivery _
0 IO 20 30 40 50 60 70 8090 ‘
IUCD E Troditionol   ’
Pills I:] Sterilization . *
Fig 2. Changes in contraceptive pructices of women ’
delivered in 1970-l97`l by Frontier Nursing Service.  
A review of the sterilizations done in the past 2 years re- i
vealed a high level of community as well as professional interest  
in this technic. These iigures are summarized in Table 2. One l
hundred and thirteen sterilizations were done. This number of  
sterilizations is the equivalent of 20% of the deliveries. Thirty-

  TABLE 2. SELEc·rEr> CHARACTERISTICS or 113 Courmas
* , M ale Female Total
Percent 38 62 100
Median age 32 27 —
; Average number of children 3.3 4.3 4.1
I.  eight percent (38%) of these were vas ligations and 62% were
 g tubal ligations. Furthermore, the average number of children in
 l the sterilized couples is 4.1, and there is an average of 1 less
 C child in those families in which the husband had a vas ligation
 i than in those in which the wife had a tubal ligation.
 f These data document the effectiveness of family plamiing
i where it has been included in a rural program of comprehensive
 { health care by the Frontier Nursing Service for a population of
 Q 18,000 scattered over 750 square miles of mountainous country-
 } side. It has rcsolved the manpower problem by using a team of
 J nurse-midwives with physician backup. In using nurse-midwives
 Q decentralized into district clinics, the transportation problem is
 g decreased and existing facilities reutilized.
 A In the Leslie County area of the Frontier Nursing Service,
 ~ this nurse-midwifery program has decreased the birth rate from
j 41 to 15 over a 10-year period in an 11,000 population area; the
,_  principal physician input has been to assist in the training of
` nurse-midwives and to provide surgical sterilizations to patients
they have motivated.
_" The mechanics of birth control are thus established and can
j be measured. The Frontier Nursing Service can now refocus on
i the real aim of Family Planning—ie, the quality life-—to assure a
l high standard of growth and development for those children
, whose families have planned them.
1. Schutt BG: Frontier‘s family nurse. Am J Nurs. 72:903-909, 1972
’ 2. Taylor HC, Berelson B: Comprehensive family planning based on maternal/child
V health services. Stud Fam Plan 2:1-54, 1971
3. Beasley WBR: Nurse midwives as mediators of contraception. Am J Obstet Gyne-
il col 98:201—207, 1967
V 4. Beasley WBR: Extension of medical services through nurse assistants. J Kentucky
  Med Assoc {$7:101-106, 1969
’ 5. Extending the scope of nursing practice. Am J Nurs 71:2346-51, 1971
Q 6. Frontier Nurse Practitioners Program. Q Bull Frontier Nursing Service 47:31, 1971
* 7. Report on the Tenth Thousand Conflnements and on the First Thousand Contine-
' ments of Frontier Nursing Service, Inc. Metropolitan Life Insurance Company, Q
» Bull Frontier Nursing Service Vol 33, 1958
8. {Division of Bio-Statistics; Department of Public Health; Commonwealth of Ken-

One of the friends Ben Franklin made in Paris during his  
term as envoy to France was Dr. Joseph I. Guillotin, a physician  I
who served with Franklin on a royal committee to investigate 9
mesmerism. This was in 1784. ‘
Yes, this Dr. Guillotin is the same man for whom the guillo- `
tine is named, and a good many think that the Doctor invented A
the lethal machine. Not so. He didn’t invent it, nor was he a g
revolutionary. P 
In fact, he nearly became an American. Franklin expounded  ,;
so eloquently on the advantages of the new world in the Colonies  
that the Doctor decided to organize a group and emigrate. How-  
ever, he would Hrst send an advance party headed by his son-in-  
law and others to scout the territory, while he stayed in Paris.  
Making their way to Philadelphia, the advance party was warmly  j
received by Franklin, who by then was back in this country. They  Q
continued West, hoping to travel down the Ohio River. This was  
where the trouble started, and it included boat wrecks, hostile  
Indians, sickness and hunger. Discouraged, the advance par|;y  ,;
eventually returned to Paris. Dr. Guillotin cancelled plans for  if
emigration.  R
It was not until 1789 that the Doctor entered civic life as a Q 
member of the French Assembly. His proposal for development  p
of the French guillotine was based simply on the thought that the  
form of capital punishment ought to apply equally to all classes  _»
of people, the poor as well as the rich. Someone else actually
designed the French machine, based on models which had been `
used as early as the 13th century elsewhere.  “
The Assembly honored Dr. Guillotin for his "reform" pro-  =
posal by naming the machine after him, and as everyone knows, _
the guillotine got an awful lot of use during the French Revolu-  `
The knife fell on some 2500 necks during the days of the .
Terror. And in what was almost a trick of fate, one of those in
prison awaiting sentence in July, 1794, was the good Dr. Guillotin  
himself. Robespierre went first, however, and the revolution was A
over, saving the Doctor for many more years. He returned to  i
medical practice, founded the Paris Academy of Medicine, worked  i
extensively on vaccination, and lived on until 1814. ”
——The Colonial Crier, May-June, 1971 ‘
Colonial Hospital Supply Company
Chicago, Illinois

 A- The graduation ceremony for the 65th Class in the Frontier
f School of Midwifery and Family Nursing was held in St. Chris-
Y, topher’s Chapel at Hyden on the evening of January 20, 1973.
[ The students had asked Dr. Anne Wasson to be their graduation
 g speaker and she said, in part:
”  "Miss Browne has said several times that ‘medicine cures and
? nursing cares’. It has always distressed me to hear this but I
  have come to believe that this is true. Medicine needs to learn
_,  to care as nursing does, for much of what we see as physicians
  cannot be ‘cured’ in the true sense of the word and ‘caring’, or
 i understanding, makes the difference to the patient, providing
 E hope in many chronic situations. We have made a beginning,
 “ with the broadening of this course, to bring medicine and nurs-
 _ ing together as a team to care for families as a unit, to help them
 i solve the problems of living. As nurses you have, with training,
 ii improved your skills to allow you to become the extended arm
` of the physician. As a team we can better provide the needed
services so lacking in much of the practice of organized medicine
 , today. You have accumulated knowledge and skills needed for
  handling the problems of living which are the background of the
` common ailments which many people must learn to handle and
live with.
Q "I know I speak for the entire team of clinical instructors
  in all three phases of your training when I say ‘we hope we have
given you skills to broaden your horizons as nurses’. For my
 y part, I hope that my small contribution has opened a new vista
 l for you so that you now have a method of investigation of medi-
 · cal problems and a way to continue to learn to develop your
. skills through reading and thoughtful practice with your pa-
tients. Final examinations. are not the end of your training.
 - This year is the beginning of the rest of your medical experience
I —a base from which to grow—an exciting look into new horizons
 ` which can be yours.
"To Margaret Bartel, who joins us to work at the Bob Fork
Clinic, and to Nikki Jeffers, who will expand pediatrics both by
establishing clinics for well child care and as an instructor, we
. say ‘welcome to the team'. To Jo Brady, who leaves for further

 12 rnonrmn NURSING snavicm V
work in maternal and child health and family planning in her ,
Florida Health Department, and to Esther Mack who leaves for i
work in Tanzania, we say ‘go with best wishes from your hos-  _
pital family on the hill’. `
"Godspeed." ·
In speaking for the graduating class, Mary Jo Brady £
responded: —
"When I came to FNS as a student, I decided I would do
anything that was asked of me. I was determined to adjust to
my situation and do my best, whatever was required of me. But
when my classmates asked me to express our thanks as a class,
I just about broke my resolution; in fact, I tried every way pos-
sible to wiggle out of it! It was just too monumental a task.
How can one say thanks to a whole mountain? I could begin by l
thanking Trudy Isaacs for her guiding hand throughout, and Dr.
Wasson for taking us under her wing and into her heart, knock- _
ing down boundaries we had never dared cross and making nurse
practitioners of us. Then there was Phyllis Long and Dr. Beasley
in the intensive midwifery course, making us believe we had never
heard the word pregnancy before, and Molly Lee whose heart is ·
bigger than her Wellington boots! I can’t go on naming names
as there are so many to whom we owe special thanks-—the `house-  .
keeping, maintenance and nursing staff, the faculty, the super- ._ 
visors, the dear patients, the town, the whole FNS. Since we E
obviously cannot give a tangible gift to each, we have decided I
we will try to carry forth in our daily lives the love and warm- i
hearted total acceptance we have found here and try to spread
the attitudes of the FNS beyond the mountains and in our per-
sonal contacts, wherever the pathways of life may lead us. This, ,
then, will be our way of expressing our thanks to all who have
been our guiding hands during our student lives."
Overheard: Visitors on the way to the Intensive Care Unit
asked for directions to the "Expensive Care Unit". I

Z by
From a paper prepared by the author when a student in Family Nursing
"Sanitation is a way of life. It is the quality of living that
is expressed in the clean environment."1
"Health Education is the process by which individuals and
` groups of people learn to promote, maintain or restore health. To
be effective, the methods and procedures used to achieve this aim
g must take account of the ways in which people develop various
forms of behavior, of the factors that lead them to maintain or
to alter their acquired behavior, and of the ways in which peo-
ple acquire and use knowledge. Therefore, education for health
. begins with people as they are, with whatever interests they may
have in improving their living conditions. It aims at developing
 _ in them a sense of responsibility for health conditions, as indi-
 i viduals and as members of families and communities. In com-
  municable disease control, health education commonly includes
i an appraisal of what is known by a population about a disease;
j an assessment of habits and attitudes of the people as they re-
late to spread and frequency of the disease; and the presentation
of specific means to remedy observed deiiciencies."2
, The purpose of this compiled information in reference to
sanitation and its related principles of promotion and mainten-
ance of Health was motivated by a Family Nurse’s need and
· attempt to acquire more knowledge about living habits and con-
ditions of her rural Appalachian community. This grass-root
— information seemed imperative to an honest effort to promote
health concepts and prevention of disease.
· Rural Preventive Health Measures:
1. Prevention of soil contamination by installation of sani-
tary disposal systems, especially sanitary privies in rural areas,
 ky State Department of Health Information Bulletin
_ 2. Control of Conmzunicable Diseases in Man, Abram S. Benenson, Editor

 14 FRONTIER NURSING smnvrcm l
supervision of indoor plumbing and septic tank where there
are indoor toilet facilities.
2. Protection of public water supplies against contamina— {
tion; health education of rural area population in methods of `
water purification. A
3. Health education of the general public in personal 1
hygiene. A
4. Fly control and protection of foods against ily contami-
nation by screening or other appropriate means.  A
5. Boil or pasteurize milk of animals of suspectable species g
in endemic areas. ~
6. Community survey to determine density of vectormos- j
quitoes, to identify breeding places, and to promote plans for
elimination. s
7. Rat control. .
8. Supervision by health agencies of the health and sanitary _
practices of persons preparing and serving food in public eating
places; also general cleanliness of the premises. l
9. Supervision of school sanitation. j
10. Supervision by health agencies of waste disposals such .
as garbage and rubbish; health education of the general public  .
regarding waste disposal.
11. Education of public to avoid swimming or wading in ~
contaminated waters. ii
12. Education of all persons, particularly children, in pre-
vention of infection by parasites and protozoa.  
13. Health education of the need for immunizations and
good nutrition.
14. Prevention and control of communicable diseases. 4
Water is essential to our biological, cultural and economic .
The human body has a great need for water. Composed of
more than 70% water, it needs the liquid to regulate its tem-
perature and to help eliminate wastes; and, at least 500cc is
needed daily to replenish the amount that the body loses in .
everyday activity.
Because of the ability of water to serve as a medium for

transmitting the etiologic agents of certain diseases, it is im-
Y portant that we have an understanding of the 1) principles in-
. volved in the protection of domestic water supplies and, 2) the
‘ essential steps in the preparation of potable water. It is the
A purpose of this report to provide basic knowledge in these two
f areas.
The unending hydrologic cycle of precipitation, runoff, in-
A filtration, storage, evaporation and reprecipitation replenishes
. water supplies from wells and surface streams. Man gets his
L water at the most convenient point in this cycle. The water is
used and returned to its original source or not, depending upon
j the method of disposal of wastes.
I) Cisterns: When surface or spring and well sources are not
. adequate, or the physical quality of the water from them is un-
 1 satisfactory, rain water is collected and stored in cisterns. Rain
water can be contaminated and it will absorb oxygen, carbon
dioxide and nitrogen. To a more limited extent, it absorbs cer-
‘ tain rare gases, together with atmospheric dust. Rain water
T collected from roofs can be contaminated by dust, leaves and bird
droppings that accumulate between storms. Even with a sand
` filter to strain the rain water before it enters a cistern, it is
essential that a flapper valve be installed on the roof spout to
Q discharge the first flush from a rainstorm to waste.
» II) Ground Water Supplies: When rain falls or snow melts, some
of the water seeps into the soil. This seepage varies with the
, capacity of the soil to transmit water. This process is called
infiltration and the imiltrated water is the source for springs and
‘ wells. Wells to collect this source can be dug, driven or drilled.
" Dug Wells: There is a recommended method of installing
l and protecting a dug well against superficial surface water. It
is constructed by excavating through the top soil until a water-
bearing sand or gravel formation or a creviced water—bearing
rock is encountered. Dug wells are from four to six feet in dia-
meter and range from 10 to 40 feet deep. As a rule, they are
not fully protected against contamination from surface sources.
U If care is taken in their location and construction, protection is
generally satisfactory. It is essential to locate the well above

 is Fnourmn Nunsmc smnvicm  
and as far as practical from such sources of pollution as privies, f
cesspools and septic tanks. Otherwise, gross contamination of
the water—bearing stratum can occur. ,
Driven Wells: Shallow wells are frequently driven where
the ground water may be reached at 20 feet or less and where ,
there is no intervening rock. They are easy to .sink and can be  i`
readily protected against direct surface contamination. Since
the source is near the surface, special care must be taken in .
locating a driven shallow well away from privies, cesspools or I
other pollution drainage. I
Drilled Wells: When water-bearing sand and gravel forma- ‘
tions are overlaid with hardpan and clay or rock of considerable
thickness, drilled wells must be installed. They are usually deep ;
and the water-bearing stratum is reached by drilling through .
the various strata. The essential considerations are to develop Q
the water-bearing stratum free from contamination and protect
the well both at the bottom of the casing and at the top. Wells
drilled in limestone should not be used until bacteriological test
results have been obtained. These should have bacteriological
examinations made at periodic intervals, and the well should be ‘
abandoned or treated if the analysis is unsatisfactory. .
III) Springs—are classified into three distinct types: {
Shallow springs issue from superficial water-bearing sand ;
or gravel and reach the surface at the foot of slopes. Such i
springs can be contaminated by surface sources and ordinarily  
can be recognized by their seasonal temperature variation. Since T
the source of water is near the ground surface, the spring’s p
temperature is aHected by air temperatures. The water may '
approach 32 F. in the winter and 60 in summer. 3
Deep springs issue from porous strata or fissures located  ‘
between the impervious strata, and reach the surface at points t
where the water-bearing strata outcrops. When they are located ·
below possible sources of contamination, care should be taken.
The temperature of water issuing from deep springs varies only
by a few degrees from winter to summer. The reason for the
uniform temperature is that the rain water from which the V
spring is derived has been in contact with the deep strata long V
enough to be at ground temperature of about 50 F.

A Limestone springs are found where water issues from out-
cropping solution channels in limestone.
< It is essential that all springs be properly developed and
protected from nearby sources of contamination.
{ IV) Surface w